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Hemorrhage Control on the Battlefield

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Survival with emergency tourniquet use to stop bleeding in major limb trauma.
Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB.
Ann Surg. 2009 Jan;249(1):1-7.

Rationale for inclusion:  This is a relatively large study on the use of tourniquets in a combat hospital. The results are striking in that tourniquet use when applied early (before evidence of shock) was associated with survival in 90% versus 10% when applied in those already in shock.

Citations - 377 (as of July 2017)

QuikClot use in trauma for hemorrhage control: case series of 103 documented uses.
Rhee P, Brown C, Martin M, Salim A, Plurad D, Green D, Chambers L, Demetriades D, Velmahos G, Alam H.
J Trauma. 2008 Apr;64(4):1093-9.

Rationale for inclusion: This is unique study in that both military and civilian, surgeons and pre-hospital providers used Quickclot for hemorrhage control in over 100 cases. It was found to effective, especially in the pre-hospital setting. Only 3 cases of burns were encountered.

Citations - 181 (as of July 2017)

Practical use of emergency tourniquets to stop bleeding in major limb trauma.
Kragh JF Jr, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB.
J Trauma. 2008 Feb;64(2 Suppl):S38-49; discussion S49-50.

Rationale for inclusion: This study on tourniquet use on combat injured patients provides data that supports very minimal morbidity associated with tourniquet use including nerve palsy and no limb loss due to tourniquet use in this study. 

Citations - 317 (as of July 2017)

Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.
Beekley AC, Sebesta JA, Blackbourne LH, Herbert GS, Kauvar DS, Baer DG, Walters TJ, Mullenix PS, Holcomb JB; 31st Combat Support Hospital Research Group.
J Trauma. 2008 Feb;64(2 Suppl):S28-37; discussion S37.

Rationale for inclusion:  This is another study on tourniquet use at a combat hospital that further supports the use of tourniquets to aid in hemorrhage control in extremity injuries. No adverse outcomes were cited, and tourniquet use might have positively impacted potentially preventable deaths.

Citations - 285 (as of July 2017)

Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience.
Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, Ben-Abraham R.
J Trauma. 2003 May;54(5 Suppl):S221-5.

Rationale for inclusion:  This study utilizes data that mostly pre-dates the US involvement in the Iraq and Afghanistan. The Israeli Defense Forces provide data supporting tourniquet use by pre-hospital medical and non-medical personnel as means of hemorrhage control in those with exsanguinating extremity wounds.

Citations - 253 (as of July 2017)

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Eastern Association for the Surgery of Trauma

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